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Impact of maintenance therapy post autologous stem cell transplantation for multiple myeloma in early and delayed transplant

Bone Marrow Transplantation volume 57, pages 803–809 (2022)Cite this article

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Abstract

Based on phase 3 trials, maintenance therapy after autologous stem cell transplantation (ASCT) has become the standard of care in multiple myeloma (MM). We examined the trends in maintenance therapy in a large group of patients (2530) transplanted at a single institution over two decades. Majority (n = 1958; 77%) had an ASCT within 12 months of diagnosis (early ASCT). Maintenance was employed in 39% of the patients; 42% among early ASCT and 30.5% among delayed ASCT. Most common maintenance approach was an IMiD (61%), followed by a PI (31%), or a PI + IMiD (4%). Patients with high-risk FISH received PI-based maintenance more frequently. The PFS was superior with maintenance (36 vs. 22 months, p < 0.001); 37 vs. 25 months for early ASCT (p < 0.001) and 29 vs. 17 months for delayed ASCT (p = 0.0008). OS from ASCT was higher with maintenance for the whole cohort at 93 vs. 73 months (p < 0.001). OS from diagnosis was also better for the whole cohort with maintenance therapy, 112 vs. 93 months (p < 0.001). The improvement in PFS and OS was seen in high-risk and standard risk disease. The experience with maintenance therapy post ASCT for myeloma in a non-clinical trial setting confirms the findings from the phase 3 trials.

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Data availability

SK has not yet deposited the data in a repository. The datasets generated during and/or analyzed during the current study are not publicly available due to patient privacy concerns but are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Community Internal Medicine, Mayo Clinic Health System, Albert Lea, MN, USA

    Dhauna Karam

  2. Department of Hematology, Mayo Clinic, Rochester, MN, USA

    Morie Gertz, Martha Lacy, Angela Dispenzieri, Suzanne Hayman, David Dingli, Francis Buadi, Prashant Kapoor, Taxiarchis Kourelis, Rahma Warsame, William Hogan & Shaji Kumar

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  1. Dhauna Karam
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Contributions

Conception and design: DK and SK. Collection and assembly of data: all authors. Data analysis and interpretation: DK and SK. Manuscript writing: DK and SK. Final approval of manuscript: all authors. Accountable for all aspects of work: all authors.

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Correspondence to Shaji Kumar.

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Karam, D., Gertz, M., Lacy, M. et al. Impact of maintenance therapy post autologous stem cell transplantation for multiple myeloma in early and delayed transplant. Bone Marrow Transplant 57, 803–809 (2022). https://doi.org/10.1038/s41409-022-01631-8

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